Nancy Pelosi’s irrational behavior regarding the Medicare “doc fix” is creating rifts between Pelosi and other Democrats. For the past several months we’ve had a repeated pattern of the Democrats taking the lead in trying to fix the problem while the Republicans have blocked passage. Suddenly it is Nancy Pelosi who is jeopardizing Medicare.

The Senate passed a six month temporary fix last Friday which differed from the House proposal. While far from perfect, the Senate bill would have at least bought some time to again work on a long term solution. It was initially assumed that the House would quickly approve the Senate bill but instead Pelosi has insisted she will not act upon a Medicare fix which does not also include the jobs proposals in the House bill.

While fighting for the jobs proposals are admirable, this should not be done at the expense of passing the Medicare fix. Failure to pass the fix endangers the Medicare program and will cause seniors, the disabled, and military families to have difficulty getting access to health care. (Medicare directly covers seniors and the disabled while Tricare, which covers active members of the military and their families, bases its fee schedule on the Medicare fee schedule).

As Nancy Pelosi and Harry Reid took differing positions, Politco reported this morning that Congress battles as Medicare burns. There even appears to be some disagreement with Pelosi among the House Democratic leadership, as reported by The Hill:

Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, tells The Hill that Congress should quickly pass a bill delaying cuts to Medicare physician payments. The comments seem at odds with House Speaker Nancy Pelosi’s (D-Calif.) statement Monday that the House should hold off on taking up the Senate’s Medicare doc fix until the Senate passes a tax extenders bill, which some House members fear might go nowhere if it’s uncoupled from the must-pass doc fix.

“Leverage is less important than ensuring seniors can see their doctors,” Andrews said as he was entering a meeting in the office of House Majority Leader Steny Hoyer (D-Md.). “So I think it’s important to pass it.”

As I said earlier as my Facebook status, also posted to Speaker Pelosi’s FB page (and on Twitter in an abreviated 140 character version):

Nancy Pelosi: We expect Democrats to fight to preserve Medicare, not give Republicans political cover to destroy it. So far it has been the Republicans who have been blocking the payment fix, but if you follow through with threats not to pass the latest temporary fix passed by the Senate the Democrats become responsible for endangering Medicare, and risk losing the senior vote.

USA Today reports that “The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.” There have always been doctors who do not accept Medicare due to lower payment rates compared to private insurance but the number is now increasing due to uncertainty about future payments due to the flawed physician payment formula:

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

In past years Congress has acted at the last minute to override steep cuts called for under the payment formula but this year there has been increased uncertainty as the Republicans have repeatedly played politics to prevent a long term fix. If the scheduled 21% cut is not reversed it is anticipated that far more doctors will stop accepting Medicare patients. This cut would place Medicare payment closer to the level of Medicaid, which already suffers from difficulties in access to care.

Medicare not only covers those over the age of 65. The program covers many who are disabled, and the Tricare program which covers U.S. military personnel and their families also pays based upon the Medicare fee schedule.

This year, after attempts at a permanent fix were blocked, the fee cuts have been blocked in temporary measures which have only been effective for one to two months. The Senate finally passed a six month fix last week but payments from June were already being sent out at the reduced rates. The fix would restore the cut fees retroactively but now Nancy Pelosi is threatening that the House will not pass this until the Senate also passes a jobs bill. While a jobs bill is also necessary, these are two separate issues and Medicare beneficiaries should not be forced to suffer while Congressional Democrats are fighting to pass a jobs bill.

Harry Reid might be the leader of a House of Congress from Nevada but it is Nancy Pelosi who has turned into quite a gamble–a gamble which if she loses will probably turn the Democratic Party back into a minority party. On Friday the Senate passed a six month Medicare “doc fix” but regrettably could not also pass jobs legislation. Now Nancy Pelosi is threatening that the House will not pass the Senate bill until they also pass jobs legislation.

If her gamble works and the Senate passes the original House bill as opposed to the more limited Senate bill then Nancy Pelosi will come off as a legislative genius. However this is a very high stakes gamble. If she fails then it will be the Democrats who will receive much of the blame for the failure of passage of the Medicare fix.

Failure to pass the Medicare fix will lead to serious limitations on medical care for the elderly and disabled individuals now on Medicare. In addition, Tricare pays based upon the Medicare fee schedule so this will also adversely affect U.S. military personnel and their families.

Conservatives already are beginning to realize that Nancy Pelosi might have handed them a tremendous gift. Ed Morrissey writes:

In other words, Pelosi has handed the Senate Republicans the key to a filibuster not just in the Senate but also in the House, all to demand a massive expansion of the deficit on two separate fronts. The GOP couldn’t have possibly asked for a better political position even if they had begged Pelosi not to throw them into that briar patch. And if the “doctor fix” fails to get out of the House, it won’t be Republicans who get the blame, since Pelosi can call a vote on that any time she desires.

Let’s hope that Republicans manage to keep this advantage for as long as it takes Pelosi to realize that she’s blown it.

Morrissey is incorrect on an earlier point claiming, “the passage of the ObamaCare legislation whose financials were specifically predicated on keeping the Medicare reimbursement cuts in place.” A permanent fix was originally planned to be part of health care reform but Republicans made this politically impossible by counting the paper costs of this fix as part of the health care legislation.

Regardless of countless acts by the Republicans to play politics here and block a permanent fix, Morrissey is correct that the Democrats will pay the price politically if Nancy Pelosi is the one to prevent passage of the fix which has now passed the Senate. Loss of the senior vote will be devastating to the Democrats.

The AOA has joined the AMA in endorsing the health care reform legislation along with making recommendations for changes. The recommendations include eliminating the flawed physician payment formula and significantly modifying or abolishing the Independent Payment Advisory Board.

Following is the text of the item in today’s AOA Daily Report which includes their letter to President Obama, Speaker Pelosi, and Majority Leader Reid:

The full AOA Board of Trustees convened today to finalize the AOA’s official position on health system reform legislation as Congress nears a final vote after a year-long debate. The Board examined how the bill aligns with AOA policies established by the AOA House of Delegates over the last 30 years and developed a letter to President Obama, Speaker of the House Nancy Pelosi, and Senate Majority Leader Harry Reid delineating our unanimous support of advancing the legislative process as well as our strong recommendations on how to ensure access to care, promote primary care, provide for fair physician payment, and reduce overall health care costs, especially by enacting federal PLI reform. Read a copy of the letter here.

Earlier I posted a copy of a statement faxed and emailed to physicians in support of the legislation by the American Medical Association along with links to letters sent by the AMA with their suggestions for improvements in the legislation.

The American Medical Association which previously endorsed passage of the House and Senate health care reform bills has sent out a fax to physicians supporting passage of the revised bill to be voted upon this Sunday. The fax states that “We worked hard and made significant progress toward resolving” problems with the original Senate bill. They also state there are issues “that cannot be addressed through the current reconciliation process and will need to be address by Congress and the administration.”

The AMA calls for changes including repealing the Medicare sustainable growth rate formula, making changes in the Independent Payment Advisory Board, the cost-quality value index, rules for data release, and enactment of effective medical liability reforms.

While they consider this bill “an imperfect product” and see problems in the bill which I agree with, the AMA concludes that this bill “does, in fact, improve the ability of patients and their physicians to achieve better health outcomes.”

While CNN began with a reputation for being a liberal network, it has increasingly become the Conservative News Network since being sold by Ted Turner. While certainly not as far right as Fox, and preserving some degree of journalistic integrity, CNN has hired far more Republicans than others in the past several years. There is yet another addition–Erick Erickson of Red State.

Steve Benen finds this pick to be far worse than all the other conservatives which CNN has hired in recent years:

This is easily the worst decision CNN has ever made. That the network probably reviewed Erickson’s work before hiring him, and offered him a job anyway, suggests CNN’s professional standards for what constitutes “an important voice” have all but disappeared.

The point here isn’t that it’s disappointing to see CNN hire yet another conservative voice, adding to its already-large stable of conservative voices. To be sure, it’s frustrating, but it’s nothing new.

The problem here is with Erickson himself.

For example, it wasn’t long ago when Erickson explained his belief on why the left has a stronger online presence than the right. He attributed it to an asymmetry in free time, since conservatives “have families because we don’t abort our kids, and we have jobs because we believe in capitalism.”

This is the same Erickson who recently called retiring Supreme Court Justice David Souter a “goat f–king child molester,” referred to two sitting U.S. senators as “healthcare suicide bombers,” praised protesters for “tell[ing] Nancy Pelosi and the Congress to send Obama to a death panel” (he later backpedaled on that one), and described President Obama’s Nobel Prize as “an affirmative action quota.”

And perhaps my personal favorite was the time, just last year, when Erickson was angry about new environmental regulations relating to dishwasher detergent. He told his readers, “At what point do the people tell the politicians to go to hell? At what point do they get off the couch, march down to their state legislator’s house, pull him outside, and beat him to a bloody pulp for being an idiot?”

There was a point when major professional outlets would look at a voice like this as an “extremist,” to be shut out of the mainstream of America’s civil discourse. CNN, however, considers this record of radical rhetoric, and concludes it should pay him to offer on-air political commentary.

CNN will no doubt hear about blog posts like this one, and assume that liberals are angry because the network hired a right-wing blogger. But that’s not it — there are thoughtful, intelligent conservative bloggers in the country, who occasionally have insightful things to say. The problem here is that Erick Erickson isn’t one of them.

The recent accidental release of a presentation for donors prepared by the Republican National Committee continues to create embarrassment. The presentation shows how the GOP, lacking any real policies, tries to fool donors with appeals based upon fear. Ben Smith reports on one former donor who has decided not to contribute to the party:

A prominent Evangelical figure and Republican donor says he will end his contributions to the organized Republican Party in reaction to the leaked fundraising presentation that advised using “fear” to solicit contributions and displayed an image of President Obama as the Joker from Batman.

Mark DeMoss, who heads a major Christian public relations firm in Atlanta and served as a liaison to the Evangelical community for Mitt Romney in 2008, wrote Chairman Michael Steele yesterday that he was “ashamed” of the presentation, calling depictions of Obama, Speaker Nancy Pelosi, and Majority Leader Harry Reid “shameful, immature and uncivil, at best.”

“I’m afraid the presentation is representative of a culture and mindset within the Republican National Committee,” DeMoss, a past member of the RNC’s “Eagle” program for top donors who gave the party $15,000 in 2008, wrote in the letter to Steele, which he shared with POLITICO. “Consequently, I will no longer contribute to any fundraising entity of our Party—but will contribute only to individual candidates I choose to support.”

Personally I think people should have become wise to the minset of the Republican National Committee when they sent out fund raising letters in 2004 trying to scare people by saying John Kerry would take away their bibles. Better late than never. The full text of the letter is under the fold:

The Republican Party is doing better at present than most would have expected last year but they still have the same fundamental problem: they are wrong on all the issues. Their arguments continue to be based by making multiple claims which are counter to fact. That’s the hand they have, and they are going all out with it.

Politico has obtained a copy of a presentation from the Republican National Committee outlining their strategy of conning donors they denigrate into contributing money by raising false fears about Obama and socialism:

In neat PowerPoint pages, it lifts the curtain on the often-cynical terms of political marketing, displaying an air of disdain for the party’s donors that is usually confined to the barroom conversations of political operatives.

The presentation explains the Republican fundraising in simple terms.

“What can you sell when you do not have the White House, the House, or the Senate…?” it asks.

The answer: “Save the country from trending toward Socialism!”

Manipulating donors with crude caricatures and playing on their fears is hardly unique to Republicans or to the RNC – Democrats raised millions off George W. Bush in similar terms – but rarely is it practiced in such cartoonish terms.

One page, headed “The Evil Empire,” pictures Obama as the Joker from Batman, while House Speaker Nancy Pelosi and Senate Majority Leaders Harry Reid are depicted as Cruella DeVille and Scooby Doo, respectively.

The documents also discusses how to approach different groups of donors:

The most unusual section of the presentation is a set of six slides headed “RNC Marketing 101.” The presentation divides fundraising into two traditional categories, direct marketing and major donors, and lays out the details of how to approach each group.

The small donors who are the targets of direct marketing are described under the heading “Visceral Giving.” Their motivations are listed as “fear;” “Extreme negative feelings toward existing Administration;” and “Reactionary.”

Major donors, by contrast, are treated in a column headed “Calculated Giving.”

Their motivations include: “Peer to Peer Pressure”; “access”; and “Ego-Driven.”

The slide also allows that donors may have more honorable motives, including “Patriotic Duty.”

A major Republican donor described the state of the RNC’s relationship with major donors as “disastrous,” with veteran givers beginning to abandon the committee, which is becoming increasingly reliant on small donors.

John McCain was on Meet the Press again today. When did they pass the Constitutional amendment saying that the person with the most electoral votes becomes president, and the person who comes in second becomes a regular guest on Meet the Press? Is he being prepared to become the next host of the show?

On This Week Nancy Pelosi sounded confident of obtaining enough votes in the House to pass health care reform in the House. The House has already passed one health care reform bill but now must pass one to match the one passed in the Senate.

Going into President Obama’s first State of the Union Address we continue to get mixed signals as to plans to proceed with health care reform. White House communications director Dan Pfeiffer did say that Obama will reiterate his commitment to health care reform.

Members of the House are saying that they are willing to consider passing the Senate bill along with passing a second bill with fixes which will be passed as part of budget reconciliation where only a simple majority is needed for passage. However House Speaker Nancy Pelosi is also talking about a two track effort to pass simpler matters first and more comprehensive reform at a later date. Considering the degree of opposition to the bill nationally, as well as opposition to passing the Senate bill in the House, this might be the most realistic path.

Passing a more scaled-back plan with promises of more comprehensive reforms in the future might not be accepted by the left but Bennie Sanders, one of the most liberal member of the Senate, has signaled his willingness to support a scaled-back effort.

It might not even be necessary to scale back a new bill very much. Polls show that half the country want to start over, but that those who say this do not know what is actually in the bill. Theoretically Congress could pass a new bill which is virtually the same as the old bill, name it New Health Care Reform, and most voters would not know the difference. What would matter is explaining the individual components as polling has been clear that while Americans might say they oppose Obama-care in general they also support all the key aspects when asked specific questions.